Funder by the Department of Human Services Auspiced by Our Community


'Two Hats' is a term we have chosen to describe clinicians who also live with a 'mental illness'.

In the community, and within the mental health sector, we construct a false reality that there are two discreet groups: (1) clinicians and (2) 'patients'/'clients'. Despite the ongoing public message that "one in five people has a mental illness," there is an enduring myth that clinicians couldn't possibly be diagnosed with 'mental illness'.

Simple mathematics shows that there must be many clinicians working in mental health, child 'protection', Centrelink and other services who do have 'mental illness'.

Two Hats and consumer workers

Over the last decade there has been an escalation in the number of consumers employed in mental health services, both non-government and clinical, around Australia.

These have been working in advocacy positions, as consumer consultants, Personal Helpers and Mentors (PHAMs) and now, increasingly, in administrative positions. In these jobs people are employed precisely because they do have a diagnosis of 'mental illness'. They are 'out' by definition.

A proportion of consumer workers are clinicians by training and sometimes by passion but they are not employed to be clinicians - in fact, quite the opposite. They are employed to not be clinicians.

This is a hard position to occupy, especially when many people are desperate to have the social status of their clinical authority restored.

Consumer workers who are clinicians are an increasingly large group whose complex needs are presently under-resourced.

However consumer workers who happen to be clinicians are not the group we mean when we refer to 'Two Hats'.

Two Hats coming out

Going public about our consumer status when we are working in clinical services as a 'clinician' is not an easy decision. It's a sad fact that some of the worst discrimination comes from within the mental health sector.

It is naïve to suggest that all our colleagues are discrimination free and that management won't become super vigilant.

Some of us find ourselves working in services that have policies that silences us. It is particularly galling to be forced to be silent when we know that the knowledge we gain by having 'been there, done that' is what drives everything we do in our practice. Sometimes the system is a long way behind where we are in progressive thinking.

Unfortunately we must remember that we are employed as a clinician and our employer has a legitimate say in deciding policy about self exposure. Silence is necessary for some if they want to maintain their employment.

Not coming out

There are clinicians who choose to be very private about their 'mental illness' status. The enormous pressure to conform to stereotypes of 'upstanding citizens' and 'community leaders' means that as a general rule choosing to come out is not an option for many clinicians.

As soon as we decide to be honest with our employer about our 'mental illness' we are open to our colleagues diagnosing us, offering treatment and telling us what their medical knowledge dictates we should do. This is inappropriate even if it is an effort to be helpful. Most of us have our own arrangements for 'treatment'. They are not at work.

We know of doctors with 'mental illness' who have 'lost it' at work. They have lost their licence to practise and when reinstated many years later and after a fight have found themselves with many pages of conditions attached to their registration by the Medical Board.

Coming 'out' and being forced 'out' are very different things. Being forced out is the worst possible way to come out. All of us must respect the privacy of consumer-clinicians who have made it clear that they want a complete break between their work and their personal life, including their experience of 'illness'.

Coming out later

An interesting phenomenon we have noted over the past few years has been for some famous medical practitioners and commentators 'coming out' to the world as they near the end of their careers. Everyone goes "oooh" and "ahh" and "aren't they brave!"

It's wonderful that such clinicians do this, but many of us would have loved them to have made the move much earlier. It's hard to know whether they would have survived and thrived in their profession if they had done so.

The view from within

One of the major issues for clinicians who have a 'mental illness' is that as they sit in staff rooms, walk around psychiatric units, listen to their peers, sit in with assessments and listen to registrars they may well hear things that as a consumer they don't like hearing.

What do you do if you wear two hats? In this area it makes no difference whether you are 'out' or not. The pain of watching poor practice is real in either case.

We know of several clinicians with a lived experience of 'mental illness' who simply can't practice because it makes them too angry. This presents a tragic loss for the profession, as well as for the individual clinician concerned.

We also know of people around Australia with lived experience who have become whistleblowers about bad practice. Not all whistleblowers are consumers but many are. Again, they are often forced to live with an unfortunate consequence, which might include losing their job or getting a bad reference for a new job. It's a terrible shame that consumers must become collateral damage when they are simply seeking to provide excellence in service provision.

Other Two Hats enact a 'consumer code of ethics', which may include the valuing of shared meaning so greatly that they do speak to individual consumer/patients from their own experience.

If found out, a decision to stick with the consumer ethical code can cause angst in the top echelon of clinical management, with disclosure to patients being seen as inappropriate and unprofessional. Two Hats have the unenviable task of balancing two competing codes of ethics and sometimes no one is pleased.

Student clinicians with Two Hats

Frequently clinical students are relieved to hear us tell 'their story', 'their secret', and they 'come out' in class. This is very tricky, especially when the student is young. It's not always safe to tell your story for the first time in public to a group of clinical peers.

Many young, enthusiastic and idealistic students are reaching for ways they can make the system better for themselves and others like them. To some extent they are naïve and vulnerable.

In practise placements many academically gifted Two Hats students come tragically unstuck. It can be galling for a student to find her/himself in a situation where their supervisor reeks of cynicism.

Students don't have the authority to take on the system ... yet. The priority here must be to stay attached to consumer politics if you can and keep documentation of all the things that upset you. This will remind you of your idealism later on when the insidious process of institutionalised pique starts to lure you into the fold.

Consumers tell us that there are some clinicians with lived experience of 'mental illness' whose own practice is less than ideal (or even terrible).

This is not so hard to believe. It happens in other areas of life as well, where people try to distance themselves from a horrible experience. Some of us behave in ways that are the opposite to what's good - from a consumer perspective - because we so much want to be 'A Professional' and get away as far as we can from the embarrassment of our 'mental illness'.